Provider Demographics
NPI:1558584144
Name:GRIFFIN, SUSAN (CADC-II)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 TIERRASANTA BLVD STE G
Mailing Address - Street 2:#233
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2616
Mailing Address - Country:US
Mailing Address - Phone:858-204-1176
Mailing Address - Fax:858-467-9009
Practice Address - Street 1:4002 PARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2600
Practice Address - Country:US
Practice Address - Phone:619-294-9852
Practice Address - Fax:619-291-2424
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3518287101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)